Provider Demographics
NPI:1053550160
Name:WELTZIEN, PAMELA A (OT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:WELTZIEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18601 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-8605
Mailing Address - Country:US
Mailing Address - Phone:715-538-1713
Mailing Address - Fax:
Practice Address - Street 1:18601 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-8605
Practice Address - Country:US
Practice Address - Phone:715-538-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2904225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist